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目的探讨直肠癌术后吻合口瘘的发生及其对肿瘤复发转移及生存期的影响。方法回顾性分析2004年3月—2011年3月,423例行直肠癌根治术的临床和病例资料,并对其进行随访。吻合口瘘的诊断主要依据临床表现和腹部CT。生存率计算及生存曲线绘制采用Kaplan-Meier法,单因素预后分析采用log-rank法。结果入选患者的平均年龄62岁,随访中位时间为56.7个月。有41例患者出现吻合口瘘,其中3例在手术后30天内死亡,而在无吻合口瘘的382例患者中,有6例在手术后30天内死亡(P<0.001)。5年生存率在有吻合口瘘的患者为52.6%,而在无吻合口瘘的患者则为63.5%(P<0.01),除外30d内死亡率,则分别为55.3%和66.7%(P=0.02)。结论虽然吻合失败发生率低,但他是一种非常严重的术后并发症,不仅影响手术期间的发病率和死亡率,而且也减少直肠癌患者的长期生存期。
Objective To investigate the incidence of postoperative anastomotic leakage and its effect on tumor recurrence, metastasis and survival in patients with rectal cancer. Methods The clinical data and clinical data of 423 cases of radical resection of rectal cancer from March 2004 to March 2011 were analyzed retrospectively and followed up. Anastomotic fistula diagnosis is mainly based on clinical manifestations and abdominal CT. Survival rate and survival curves were drawn using Kaplan-Meier method, single-factor prognostic analysis using log-rank method. Results The mean age of patients enrolled was 62 years and the median follow-up was 56.7 months. Thirty-one patients had anastomotic fistula, of which 3 died within 30 days of surgery. Of the 382 patients without anastomotic leakage, 6 died within 30 days after surgery (P <0.001). The 5-year survival rate was 52.6% in patients with anastomotic fistula and 63.5% in patients without anastomotic fistula (P <0.01), except for the 30-day mortality rates of 55.3% and 66.7% (P = 0.02). Conclusions Although the incidence of anastomosis failure is low, he is a very serious postoperative complication that affects not only the morbidity and mortality during surgery but also the long-term survival of patients with rectal cancer.